From the Guidelines
Loeffler's endocarditis and hypereosinophilic cardiomyopathy (HCM) are not exactly the same, but they are closely related conditions, with Loeffler's endocarditis representing a specific cardiac manifestation of hypereosinophilic syndrome (HES) characterized by endomyocardial fibrosis, restrictive cardiomyopathy, and thrombus formation. The most recent and highest quality study on this topic is from the American Heart Association, published in 2016 1. According to this study, Loeffler's endocarditis is characterized by eosinophilia, myocardial fibrosis, systemic thromboembolism, and acute heart failure, and likely represents the late stages of eosinophilic myocarditis. Some key points to consider in the diagnosis and management of these conditions include:
- The role of endomyocardial biopsy in the management of cardiovascular disease, as outlined in a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology in 2007 1
- The importance of reducing eosinophil counts with corticosteroids, cytotoxic agents, or targeted therapies, as well as anticoagulation and heart failure management, as discussed in the 2005 ACC/AHA guideline update for the diagnosis and management of chronic heart failure in the adult 1
- The need for early diagnosis and treatment to prevent irreversible cardiac damage, as emphasized in the 2016 study from the American Heart Association 1. Overall, while Loeffler's endocarditis and hypereosinophilic cardiomyopathy are related conditions, they require careful diagnosis and management to prevent morbidity and mortality, and to improve quality of life.
From the Research
Definition and Relationship
- Loeffler's endocarditis is a rare restrictive cardiomyopathy caused by abnormal endomyocardial infiltration of eosinophils, leading to tissue damage and fibrosis 2.
- Hypereosinophilic cardiomyopathy (HCM) is associated with Loeffler's endocarditis, as both conditions involve eosinophilic infiltration and endomyocardial fibrosis.
- Loeffler's endocarditis can be considered a manifestation of hypereosinophilic syndrome, which can lead to HCM 3, 4.
Clinical Presentation and Treatment
- Loeffler's endocarditis often presents with symptoms of heart failure, which can be refractory to medical management, and may require surgical intervention 2.
- Treatment options for Loeffler's endocarditis include corticosteroids, imatinib, and surgical intervention, depending on the severity and stage of the disease 3, 4, 5.
- Early detection and treatment of Loeffler's endocarditis can lead to significant improvement in symptoms and cardiac function, as demonstrated by cases where imatinib treatment resulted in rapid regression of eosinophilic proliferation and endomyocardiopathy 4.
Diagnostic Imaging and Involvement
- Cardiac MRI plays a crucial role in early detection of Loeffler's endocarditis, allowing for assessment of ventricular involvement and extent of fibrosis 6.
- Loeffler's endocarditis can involve both ventricles, with apical obliteration and heart failure, although isolated left ventricular involvement has been reported 5, 6.
- Echocardiography and cardiac MRI can help differentiate Loeffler's endocarditis from other conditions, such as thrombi or mobile corpora, and monitor response to treatment 4, 6.